Casey sent his second letter in two weeks to VA Secretary Eric K. Shinseki, asking when the Pittsburgh VA learned of elevated bacteria levels that led to the outbreak. He asked how the VA had been monitoring bacteria levels and when local officials told departmental leaders in Washington about the problem, among other inquiries.

The VA did not comment on when it might respond, though Shinseki has vowed to identify the cause of the outbreak and to improve communications with the public, according to Casey's office. He and Shinseki spoke by phone on Wednesday, Casey said.

"What apparently hadn't been done -- and I urged him strongly to do this -- is to communicate directly and more consistently with veterans and their families to make sure that they know what's happening, what the VA is finding," said Casey, D-Scranton.

He said he, too, grew frustrated "just getting through to people over there" at the VA.

Officials announced the Legionnaires' outbreak on Nov. 16, saying four patients developed the waterborne disease at the University Drive Campus in Oakland. The VA announced a fifth patient case on Nov. 22.

One patient died, according to the Allegheny County Health Department. Four recovered, VA spokesman David Cowgill has said. Officials are determining whether four employees became sick with Legionnaires'.

Cowgill said one case might be linked to the VA's H.J. Heinz Campus near Aspinwall, which remained under water-use restrictions on Thursday. Legionella bacteria were spotted in the tap water there, too, Cowgill said.

The VA lifted water restrictions at the Oakland hospital last week after an extensive cleaning process.

Neither the VA nor the Centers for Disease Control and Prevention has said how the outbreak materialized, though the VA reported a water-treatment system in Oakland might not have been as effective as once thought. CDC findings may be released within about a month.

Other elected officials have joined Casey in pressing the VA for explanations. Sen. Pat Toomey, R-Allentown, asked the VA to list steps taken to address the issue and ensure patient safety.

"The men and women who have bravely served our country deserve to know that their health care needs will be met in a safe and secure environment," Toomey wrote in a letter to Shinseki on Wednesday.

U.S. Rep. Mike Doyle, D-Forest Hills, said his staff has been in almost daily contact with the VA since the outbreak became public.

"We're certainly not ready to close the books on this one yet," Doyle said. "We're not ready to pass judgment, either, because we don't have all the facts."
He said critical questions center on the Oakland facility's water treatment set-up, which used a copper-silver ionization technology in place since 1993. Researchers familiar with the system said failures of the technology often stem from poor maintenance or monitoring.

"We need to understand this better and make sure controls were put in place," Doyle said.

Adam Smeltz and Mike Wereschagin are staff writers for Trib Total Media. Smeltz can be reached at 412-380-5676 or asmeltz@tribweb.com. Wereschagin can be reached at 412-320-7900 or mwereschagin@tribweb.com.